| NPI | 1467701037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGERY H RUNYAN Owner 970-946-0992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I05569) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 1042) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 6697) | |
| 1041C0700X Social Worker, Clinical (Licence: CO 9630022) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2016-01-19 |